Levonorgestrel-releasing intrauterine device therapy versus oral progestin treatment for Reproductive-Aged patients with endometrial intraepithelial neoplasia: a systematic review and Meta-Analysis
A partir d'une revue systématique de la littérature (21 études, 824 patientes), cette méta-analyse évalue l'efficacité, du point de vue du taux de réponse complète dans les 12 mois et du taux de grossesse, d'une contraception par progestatif oral et d'un dispositif intra-utérin libérant du lévonorgestrel chez les femmes en âge de procréer et présentant des néoplasies intraépithéliales de l'endomètre
Background: We conducted a systematic review and meta-analysis to examine outcomes of patients with endometrial intraepithelial neoplasia (EIN) treated with oral progestins or levonorgestrel-releasing intrauterine device (LNG-IUD). Methods: We conducted a systematic review across five databases to examine outcomes of progestational treatment (oral progestins or LNG-IUD) for patients with EIN. The primary outcome was the best complete response (CR) rate within twelve months of primary progestational treatment. Sensitivity analyses were performed by removing studies with extreme effect sizes. Secondary outcomes included the pooled pregnancy rate. Results: We identified 21 eligible studies, including 824 premenopausal patients with EIN, for our meta-analysis. Among these, 459 patients received oral progestin, while 365 patients received LNG-IUD as a primary progestational treatment. The pooled best CR proportion within 12 months was 82% (95% CI, 69-91) following oral progestin treatment, and 95% (95% CI, 81-99) following LNG-IUD treatment. After removing outlier studies, the pooled proportion was 86% (95% CI, 75-92) for the oral progestin group, and 96% (95% CI, 91-99) for the LNG-IUD group, with reduced heterogeneity. The pooled pregnancy rate was 50% (95% CI, 35-65) after oral progestin and 35% (95% CI, 23-49) after LNG-IUD treatment. Conclusions: This meta-analysis provides data on the effectiveness of oral progestins and LNG-IUD treatment within 12 months of treatment among premenopausal patients with EIN. Although based on small numbers, the rate of pregnancy after treatment is modest. These data may be beneficial for selecting progestational therapies that allow fertility preservation for patients with EIN.